PHILADELPHIA – Migraine with or without aura is associated with a significant increase in the risk of cardiovascular disease, including stroke and heart attack.
Numerous studies have hinted at the association between migraine with aura and cardiovascular events, Dr. Marcelo E. Bigal reported at the International Headache Congress.
But the population-based study he performed with his colleague, Dr. Richard Lipton, was the first to examine the association in a large national sample in which migraine, with and without aura, had been officially diagnosed according to accepted standards.
Dr. Bigal of Merck Research Laboratories, Whitehouse Station, N.J., and his co-author, Dr. Lipton of Albert Einstein College of Medicine, New York, extracted their data from the American Migraine Prevalence and Progression Study.
The study by Dr. Bigal and Dr. Lipton was the largest of migraine sufferers ever conducted.
It analyzed symptoms and treatment patterns in a representative sample of 162,576 Americans aged 12 years and older.
The cardiovascular substudy included data on 6,102 adults with migraine and 5,243 controls.
Overall, the investigators found that migraineurs were significantly more likely than controls to have diabetes (13% vs. 9%, respectively), hypertension (33% vs. 26%), and hypercholesterolemia (33% vs. 26%).
In addition, Dr. Bigal and Dr. Lipton found that Framingham risk scores also were significantly higher for overall migraine and for those with migraine with and without aura (mean 11) than they were for controls (mean 9).
Myocardial infarction had occurred in 2% of controls and 4% of migraineurs, which yielded an unadjusted odds ratio of 2.2.
Stroke occurred in 1.2% of the controls and 2% of the migraineurs–a significant 60% increased odds.
Rates of stroke were higher in those who had migraine with aura (4%) than without aura (1%), Dr. Bigal and Dr. Lipton found.
The significantly increased risks remained after adjusting for gender, age, disability, triptan use, diabetes, smoking, hypertension, and high cholesterol.
Overall, migraineurs were twice as likely as controls to have experienced a heart attack and 50% more likely to have experienced a stroke, the investigators found.
Migraineurs with aura were three times more likely than controls to have experienced either of those outcomes.
Migraineurs without aura were twice as likely as controls to have had a heart attack. However, Dr. Bigal and Dr. Lipton found that migraineurs without aura had no increased risk of stroke.
“Both migraine with and without aura are associated with cardiovascular disease and providers should be aware of these association to properly identify individuals at particularly high risk, as well as to plan treatment that targets not only migraine, but the complications potentially associated with it,” Dr. Bigal said.
Dr. Bigal is a full-time employee of Merck Research Laboratories.
Dr. Lipton has received research grants and honoraria from Merck and is a member of its advisory board.